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Canadian Journal of Anesthesia, Vol 27, 389-394, Copyright © 1980 by Canadian Anesthesiologists' Society

Systemic and Pulmonary Blood Pressure during Caesarean Section in Parturients with Gestational Hypertension

ROBERT HODGKINSON 1, FARKHANDA J. HUSAIN 1, and ROBERT H. HAYASHI 2

1 Departments of Anesthesiology, Obstetrics and Gynecology, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, Texas 78284, U.S.A.
2 Departments of Obstetrics and Gynecology, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, Texas 78284, U.S.A.

Twenty severely pre-eclamptic patients requiring caesarean section for delivery were allocated to two groups. One group received epidural anaesthesia consisting of either 20 ml of bupivacaine 0.75 per cent at L3-4 or 12ml at L1-2. The other group received general anaesthesia consisting of thiopentone, 40 per cent nitrous oxide and halothane 0.5 per cent. Mean arterial pressure (MAP), pulmonary artery pressure (PAP), pulmonary wedge pressure (PWP), and central venous pressure (CVP) were recorded at five-minute intervals for at least 60 minutes before operation and at least every two minutes during anaesthesia. Patients receiving general anaesthesia had pressures recorded every minute during tracheal intubation and extubation. There was a mean increase of MAP of 45 mm Hg, of PAP 20 mm Hg, and PWP 20mm Hg during intubation and extubation. Apart from a slight mean fall in MAP the parturients receiving epidural anaesthesia showed little change in these cardiovascular parameters.

It is concluded that tracheal intubation of patients with gestational hypertension produces an increase in MAP, PAP, and PWP which can lead to a significant risk of cerebral haemorrhage and pulmonary oedema. The value and dangers of using short-acting hypotensive agents to prevent these episodes of hypertension has still to be assessed. With epidural anaesthesia there is a danger of hypotension which can be treated with intravenous fluid replacement and ephedrine.

Note:

Read at the joint meeting of the Obstetrical Anesthetists Association and the Society of Obstetric Anesthesia and Perinatology, Birmingham, England, October 1979.






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Copyright © 1980 by the Canadian Anesthesiologists' Society.